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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Ward Jim Bob 6150 PARKLAND BOULEVARD SUITE 100 MAYFIELD HEIGHTS, OH 44124 |
VP of eClinical Development |
/s/ Jim Bob Ward, by Arthur C Hall III, his attorney-in-fact pursuant to Power of Attorney dated February 10, 2006 on file with the Commission | 02/15/2006 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Pursuant to the merger agreement by and among DATATRAK, ClickFind, Inc. ("ClickFind"), CF Merger Sub, Inc., a wholly-owned subsidiary of DATATRAK, the shareholders of ClickFind and Jim Bob Ward as shareholder representative, dated February 13, 2006, shareholders received either cash or a combination of cash, promissory notes and DATATRAK common shares for each share of ClickFind common stock. The exact composition of consideration received was determined by a formula contained in the merger agreement. The shares listed above represent the stock portion of the merger consideration received by the reporting person in exchange for all of his shares of ClickFind. The acquisition of the shares was approved by the Board of Directors for exemption from Section 16(b) under Rule 16b-3(d) of the 1934 Securities Exchange Act (the "Exchange Act"). |
(2) | In connection with the merger, the number of DATATRAK common shares received by the reporting person in the merger (as described above in footnote 1) was reduced, pursuant to the terms of the merger agreement, by 11,942 shares of DATATRAK in satisfaction of prior obligations owed to ClickFind related to the repayment of a promissory note in favor of ClickFind in connection with the exercise of stock options, as well as withholding taxes associated with equity compensation awards made by ClickFind. The disposition was approved by the Board of Directors for exemption from Section 16(b) under Rule 16b-3(e) of the Exchange Act. |